Journal of the European Society for Gynaecological Endoscopy

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Systematic review of breast cancer related lymphoedema: making a balanced decision to perform an axillary clearance

M. Göker1, N. Devoogdt2, G. Van de Putte1, J.C. Schobbens1, J. Vlasselaer1, R. Van den Broecke3, E.T.M. de Jonge1

1 Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg Campus St Jan, Schiepse Bos 6, 3600 Genk, Belgium.
2 Department of Revalidation Sciences, University Hospitals Leuven, Herestraat 49 bus 7003, 3000 Leuven, Belgium.
3Department of Obstetrics & Gynaecology, University Hospital Ghent, De Pintelaan 185, 9000 Ghent, Belgium.

Correspondence at: eric.dejonge@zol.be

Keywords:

Breast cancer, lymphoedema, axillary lymph node dissection, definition, incidence, prevalence


Published online: Jul 04 2013

Abstract

Aim: Breast cancer-related lymphoedema (BCRL) is a disabling complication developing after breast cancer treatment in a proportion of patients. Its impact on quality of life becomes more substantial as survival after breast cancer diagnosis increases. The incidence of BCRL following breast cancer treatment varies due to a lack of ¬uniform definition and measurement criteria. This review aims to determine the prevalence of BCRL following axillary lymph node dissection (ALND) as a benchmark to be used in a risk-benefit medical decision whether to proceed with ALND or not. The risk of leaving unresected non-sentinel metastatic lymph nodes with a presumed inherent risk of local recurrence will be balanced against the risk of BCRL following a potentially unnecessary ALND. Methods: Pubmed and Embase databases were searched for all publications on BCRL in order to estimate its ¬incidence and to decide on the most appropriate measurement method to use in clinical practice. Results: 51 articles were identified on BCRL incidence and measurement technique. Most studies measured BCRL based on differences in arm circumference (n = 18) or by self-reported symptoms (n = 18). The weighted average of BCRL incidence following ALND measured by self-report and circumference method was 28% and 16%, respectively. Conclusion: The importance of ALND and irradiation as part of the treatment of operable breast carcinoma is well established, but its morbidity is less well documented. We argue self-report as the most appropriate method to ¬establish a diagnosis of BCRL. Therefore a 28% risk of finding non-sentinel lymph node metastases in a completion ALND will be regarded as the cut-off in a medical decision to proceed with ALND.